Neurological complications of carotid revascularisation

J Neurol Neurosurg Psychiatry. 2012 May;83(5):543-50. doi: 10.1136/jnnp-2011-301162. Epub 2011 Dec 21.

Abstract

Carotid endarterectomy (CEA) is an effective treatment for patients with recently symptomatic severe carotid stenosis and in selected patients with symptomatic moderate carotid stenosis. Carotid artery angioplasty and stenting (CAS) is emerging as an alternative to CEA, and randomised controlled trials suggest comparable efficacy to CEA in prevention of non-perioperative stroke. Neurovascular complications can result from both procedures, usually from thromboembolism from the operated vessel, cerebral hypoperfusion causing ischaemia and, rarely, intracerebral haemorrhage. The overall incidence of perioperative strokes complicating CEA and CAS is approximately 4% and 6%, respectively, and represents a devastating outcome that the procedure was designed to prevent. Other neurological sequelae complicating carotid revascularisation include cerebral hyperperfusion syndrome, cranial and peripheral nerve injuries, and contrast encephalopathy in patients undergoing CAS. In this review, we analyse the incidence, mechanisms and perioperative management of neurological complications for patients undergoing carotid revascularisation.

Publication types

  • Review

MeSH terms

  • Angioplasty / adverse effects
  • Carotid Artery, Internal / pathology
  • Carotid Artery, Internal / surgery*
  • Carotid Stenosis / complications
  • Carotid Stenosis / surgery
  • Carotid Stenosis / therapy*
  • Cranial Nerve Injuries / epidemiology
  • Endarterectomy, Carotid / adverse effects*
  • Humans
  • Incidence
  • Peripheral Nerve Injuries / epidemiology
  • Risk Factors
  • Stents / adverse effects
  • Stroke / epidemiology
  • Stroke / prevention & control*
  • Vascular Surgical Procedures / adverse effects